Anemia is common among patients with chronic kidney disease (CKD). Anemia underlies many of the symptoms associated with reduced kidney function and is associated with increased mortality and hospitalizations [1-4].

Among CKD patients, iron deficiency is a common, reversible cause of anemia and resistance to erythropoiesis-stimulating agents (ESAs). The administration of iron is necessary for treatment of iron deficiency and, in selected patients, may allow a higher hemoglobin (Hb) in the absence of ESAs.

We use the serum iron, total iron-binding capacity (TIBC), and ferritin and calculation of the percent transferrin saturation (TSAT) to estimate iron stores. Other methods including the percentage of hypochromic red blood cells (RBCs) or reticulocyte hemoglobin (Hb) content are not widely available in the United States but may be more widely used in Europe. Bone marrow biopsies are considered the gold standard for diagnosis but are not commonly used among CKD patients. (See "Diagnosis of iron deficiency in chronic kidney disease".)

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